Study goes against weekly steroid shots in moms to help preemies

Health

Posted: Wednesday, October 03, 2001

By Lindsey TannerAssociated Press

CHICAGO -- Giving pregnant women weekly steroid shots to reduce complications in premature infants offers little or no benefit in most cases and may even lead to brain damage in newborns, researchers say.

While a single set of shots given two to seven days before childbirth can reduce the risk of lung ailments and death in premature babies, women should probably not be prescribed repeated doses, the researchers reported in Wednesday's Journal of the American Medical Association.

At issue are corticosteroids, drugs that simulate adrenal gland hormones and can reduce inflammation and help preemies mature.

A National Institutes of Health panel in 1994 recommended a course of steroid shots for women at risk of giving birth between the 24th and 34th week of pregnancy. That led many doctors to give women repeated doses.

While weekly shots in very premature infants studied reduced the risk of severe respiratory distress syndrome, a lung disorder common in prematurity, the researchers stopped the study early for safety reasons.

Their research suggested that babies whose mothers had weekly shots may be more likely to develop bleeding in the brain. Though the numbers were not statistically significant, the researchers said they also were concerned about increasing reports from other scientists of potential long-term damage stemming from repeated steroid shots, including babies being born with smaller heads and developmental abnormalities.

The infants studied were not followed long enough to determine if they had developmental abnormalities.

''Given the apparent lack of efficacy and the potential for short- and long-term neurologic damage resulting from weekly administration, we elected to 'do no harm' and stop the study prematurely,'' said the researchers, led by Dr. Debra Guinn, a maternal-fetal medicine specialist at Denver Health Medical Center.

They said their data ''strongly suggest'' that weekly steroid shots ''should not be prescribed routinely for women at risk of preterm delivery.''

The study at 13 hospitals involved 502 women at risk for preterm birth because labor had started early, membranes in the amniotic sac had ruptured, or the women had chronic diseases such as diabetes or lupus.

They received a single course of steroids over two days. Then the participants were given either a placebo or two shots of the steroid betamethasone every week for an average of nearly four weeks.

Overall, complication rates were about the same in babies in both groups. A difference was seen only in babies born before 28 weeks. Among those babies, severe respiratory distress syndrome developed in 66 percent whose mothers had weekly steroids, compared with 89 percent in the placebo group.

In an accompanying editorial, Dr. Edward Lawson of Johns Hopkins University said the findings do not answer whether the benefits outweigh the potential risks. He said that until long-term studies are done, patients should be told that weekly steroids are ''uncontrolled experimentation.''

This article published in the Athens Banner-Herald on Wednesday, October 3, 2001.